Treatment Outcomes of Patients With Overlapping Eosinophilic Esophagitis and Gastroesophageal Reflux Disease After Antireflux Surgery

Abstract

The relationship between eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) is complex, and there are scant data about the role of fundoplication when GERD/EoE overlap. We aimed to describe treatment outcomes of patients with GERD/EoE overlap undergoing antireflux surgery. We conducted a retrospective cohort study of patients with overlapping EoE and GERD who had undergone laparoscopic fundoplications. Patient demographics, clinical characteristics, EoE history, and procedural/surgical data were extracted from the medical record. Endoscopic and histologic responses were assessed for pre- and post-operative endoscopies. We identified 10 patients with GERD/EoE overlap who underwent antireflux surgery, and 9 patients underwent post-operative repeat EGD. All patients had heartburn and regurgitation symptoms that were refractory to PPI and/or persistent erosive disease, and also demonstrated signs/symptoms of EoE such as dysphagia (80%), food impaction (60%), fibrostenotic disease requiring dilation (70%), and lack of symptom or histologic response to topical steroids (70%). Patients demonstrated expected improvements in erosive esophagitis and hiatal hernia. The peak eosinophil count improved from 47.1 ± 35.9 eos/hpf to 7.8 ± 12.3 eos/hpf ( P = .02). Total EREFS score decreased from 3.0 ± 2.2 to 1.2 ± 2.3 ( P = .009). Patients who have GERD/EoE overlap can have endoscopic and histologic improvement in both conditions after fundoplication. This implies that in a subset of patients, GERD may drive an EoE response, and this must be recognized for successful treatment.